Method for harvesting graft vessel

• US 6,915,806 B2
• Filed: 01/25/2001
• Issued: 07/12/2005
• Est. Priority Date: 05/10/1993
• Status: Expired due to Fees

• Current Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Original Assignee: ArthroCare Corporation (Smith & Nephew PLC)
• Inventors: Eggers, Philip E., Thapliyal, Hira V., Pacek, James L.
• Primary Examiner(s): Cohen, Lee S.
• Application Number:
  US09/771,299
• Publication Number:
  US 20030084907A1
• Time in Patent Office: 1,629 Days
• Field of Search: 128/898, 606/32, 606/41, 606/48
• US Class Current: 128/898
• CPC Class Codes: A61B 18/042 using additional gas becoming plasma
• CPC Class Codes: A61B 18/12 by passing a current through the tissue to be heated, e.g. high-frequency current
• CPC Class Codes: A61B 18/1206 Generators therefor
• CPC Class Codes: A61B 18/1402 Probes for open surgery
• CPC Class Codes: A61B 18/148 having a short, rigid shaft for accessing the inner body transcutaneously, e.g. for neurosurgery or arthroscopy
• CPC Class Codes: A61B 18/1482 having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
• CPC Class Codes: A61B 18/1485 having a short rigid shaft for accessing the inner body through natural openings
• CPC Class Codes: A61B 18/149 bow shaped or with rotatable body at cantilever end, e.g. for resectoscopes, or coagulating rollers
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00084 Temperature
• CPC Class Codes: A61B 2017/00101 using an array of thermosensors
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2018/00029 open
• CPC Class Codes: A61B 2018/00083 low, i.e. electrically insulating
• CPC Class Codes: A61B 2018/00119 with metal oxide nitride
• CPC Class Codes: A61B 2018/00148 with metal
• CPC Class Codes: A61B 2018/0016 Energy applicators arranged in a two- or three dimensional array
• CPC Class Codes: A61B 2018/00178 Electrical connectors
• CPC Class Codes: A61B 2018/00327 Ear, nose or throat
• CPC Class Codes: A61B 2018/00392 : Transmyocardial revascularisation
• CPC Class Codes: A61B 2018/00404 : Blood vessels other than those in or around the heart
• CPC Class Codes: A61B 2018/0047 : Upper parts of the skin, e.g. skin peeling or treatment of wrinkles
• CPC Class Codes: A61B 2018/00476 : Hair follicles
• CPC Class Codes: A61B 2018/00505 : Urinary tract
• CPC Class Codes: A61B 2018/00577 : Ablation
• CPC Class Codes: A61B 2018/00583 : Coblation, i.e. ablation using a cold plasma
• CPC Class Codes: A61B 2018/00601 : Cutting
• CPC Class Codes: A61B 2018/00625 : Vaporization
• CPC Class Codes: A61B 2018/0066 : without feedback, i.e. open loop control
• CPC Class Codes: A61B 2018/00678 : upper
• CPC Class Codes: A61B 2018/00702 : Power or energy
• CPC Class Codes: A61B 2018/00726 : Duty cycle
• CPC Class Codes: A61B 2018/00791 : Temperature
• CPC Class Codes: A61B 2018/00797 : measured by multiple temperature sensors
• CPC Class Codes: A61B 2018/00815 : measured by a thermistor
• CPC Class Codes: A61B 2018/00821 : measured by a thermocouple
• CPC Class Codes: A61B 2018/00827 : Current
• CPC Class Codes: A61B 2018/00875 : Resistance or impedance
• CPC Class Codes: A61B 2018/00982 : combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
• CPC Class Codes: A61B 2018/1213 : creating an arc
• CPC Class Codes: A61B 2018/124 : switching the output to different electrodes, e.g. sequentially
• CPC Class Codes: A61B 2018/1253 : monopolar
• CPC Class Codes: A61B 2018/126 : bipolar
• CPC Class Codes: A61B 2018/1273 : including multiple generators in one device
• CPC Class Codes: A61B 2018/1467 : using more than two electrodes on a single probe
• CPC Class Codes: A61B 2018/1472 : for use with liquid electrolyte, e.g. virtual electrodes
• CPC Class Codes: A61B 2018/162 : located on the probe body
• CPC Class Codes: A61B 2018/165 : Multiple indifferent electrodes
• CPC Class Codes: A61B 2218/002 : Irrigation
• CPC Class Codes: A61B 2218/007 : Aspiration
• CPC Class Codes: A61F 2/2493 : Transmyocardial revascularisation [TMR] devices

Abstract

The present invention provides systems, apparatus and methods for selectively applying electrical energy to body tissue in order to incise, dissect, harvest or transect tissues or an organ of a patient. The electrosurgical systems and methods are useful, inter alia, for accessing, dissecting, and transecting a graft blood vessel, such as the internal mammary arteries (IMA) or the saphenous vein, for use in a by-pass procedure. A method of the present invention comprises positioning an electrosurgical probe adjacent the target tissue so that one or more active electrode(s) are brought into at least partial contact or close proximity with a target site in the presence of an electrically conductive fluid. A high frequency voltage is then applied between the active electrode and one or more return electrode(s). During application of the high frequency voltage, the electrosurgical probe may be translated, reciprocated, or otherwise manipulated such that the active electrode is moved with respect to the tissue. The present invention volumetrically removes the tissue at the point of incision, dissection, or transection in a cool ablation process that minimizes thermal damage to surrounding, non-target tissue.

Claims

1. A method of providing a graft vessel for a patient, comprising:

a) dissecting the graft vessel from connective tissue adjacent to the graft vessel to provide a free portion of the graft vessel;

b) positioning an active electrode of an electrosurgical probe in at least close proximity to a first position of the free portion of the graft vessel; and

thereafter

c) upon application of a high frequency voltage between the active electrode and a return electrode, transecting the graft vessel at the first position via localized molecular dissociation of graft vessel components.

2. The method of claim 1, further comprising:

d) positioning the active electrode of the electrosurgical probe in at least close proximity to a second position of the free portion of the graft vessel; and

thereafter

e) upon application of a high frequency voltage between the active electrode and the return electrode, transecting the graft vessel at the second position via localized molecular dissociation of the graft vessel components.

3. The method of claim 2, further comprising:

f) prior or concurrently to said steps c) or e), delivering an electrically conductive fluid to the active electrode such that the electrically conductive fluid provides a current flow path between the active electrode and the return electrode.

4. The method of claim 2, wherein transecting the graft vessel at the first position or the second position comprises moving the active electrode with respect to the graft vessel.

5. The method of claim 1, further comprising:

g) prior to said step a), accessing at least a portion of the graft vessel by removing at least a portion of an overlying tissue which overlies the graft vessel.

6. The method of claim 5, wherein said step g) comprises:

h) positioning the active electrode in at least close proximity to the overlying tissue; and

i) after said step h), applying a high frequency voltage between the active electrode and the return electrode, wherein the overlying tissue is ablated via localized molecular dissociation of overlying tissue components.

7. The method of claim 6, further comprising:

j) prior to or during said step i), delivering an electrically conductive fluid to the active electrode such that the electrically conductive fluid provides a current flow path between the active electrode and the return electrode.

8. The method of claim 6,further comprising:

k) during said step i), moving the active electrode against a surface of the overlying tissue to create an incision in the overlying tissue.

9. The method of claim 8, further comprising effecting hemostasis of the overlying tissue at the incision.

10. The method of claim 6, wherein the active electrode consists essentially of a single blade electrode having an active edge and first and second blade sides, the overlying tissue comprises the sternum, said step i) generates a high current density in the region of the active edge such that an incision is formed in the sternum, and at least one of the first and second blade sides engages the incised sternum, wherein hemostasis of the incised sternum is effected.

11. The method of claim 5, wherein the overlying tissue is a sternum, an intercostal space, or the skin of the patient.

12. The method of claim 1, wherein said step a) comprises:

l) positioning the active electrode of the electrosurgical probe in at least close proximity to the connective tissue adjacent to the graft vessel; and

m) after said step 1), applying a high frequency voltage between the active electrode and the return electrode, wherein at least a portion of the connective tissue adjacent to the graft vessel is ablated via localized molecular dissociation of connective tissue components.

13. The method of claim 12, further comprising:

n) prior to or during said step m), providing an electrically conductive fluid between the active electrode and the return electrode.

14. The method of claim 12, wherein during said steps c) and m) the graft vessel and the connective tissue, respectively, are exposed to a temperature in the range of from about 40°

C. to 70°

C.

15. The method of claim 12, wherein said step m) comprises effecting hemostasis of the connective tissue.

16. The method of claim 1, wherein said steps a) through c) are performed in a minimally invasive procedure or with laparascopic access.

17. The method of claim 1, wherein the method is performed intercostally.

18. The method of claim 1, wherein the method comprises a coronary artery bypass graft (CABG) procedure.

19. The method of claim 1, wherein said steps a) through c) are performed in conjunction with a median sternotomy.

20. The method of claim 1, wherein the graft vessel is a saphenous vein or an internal mammary artery.

21. The method of claim 1, wherein the high frequency voltage has a frequency in the range of from about 50 kHz to about 500 kHz.

22. The method of claim 1, wherein the high frequency voltage is in the range of from about 10 volts RMS to about 500 volts RMS.

23. The method of claim 1, wherein the active electrode consists essentially of a single blade electrode having an active edge and first and second blade sides.